Diagnostic imaging procedures

If your doctor says you need a high–tech scan, such as a CT or MRI, and it’s not done in an emergency room or as part of an inpatient hospital stay, your doctor must contact BCBSNC and get prior plan approval for the scan1.

For services on or after February 15, 2007, all high–tech scans and special heart studies, called nuclear cardiology studies, require prior plan approval from BCBSNC if done on an outpatient basis. These diagnostic imaging procedures include:

CT/CTA scans

MRI/MRA scans

PET scans

Nuclear cardiology studies

Not all BCBSNC policies require prior plan approval for these procedures. To see if you need prior plan approval, enter your group number, which is listed on your BCBSNC ID card, in the box below and click “Search.”

1 If your doctor is in North Carolina and is part of the BCBSNC network (i.e., an in–network or participating provider), he or she should contact BCBSNC and get prior plan approval for these services. If your doctor is not part of the BCBSNC network or is located outside of North Carolina, you must tell your doctor to get prior plan approval for you. An out–of–network or out–of–state doctor will not be familiar with BCBSNC’s prior plan approval requirements. If prior plan approval is not obtained before you have your scan, BCBSNC will not pay for the service and you will be responsible for the bill (this does not apply if you see an in–network provider). Tell your doctor to visit our Web site, www.bcbsnc.com/providers/ppa, for more information about how they can request prior plan approval for these services.